...looked at more than 700,000 single-baby births before and after the introduction of the ban.

The number of mothers who smoked fell from 25.4% to 18.8% after the new law was brought in, researchers discovered.

This, as you might expect from Pell, is a distortion of the truth. The 25.4% figure relates to 2001, some five years before the ban was introduced. Any honest researcher would surely use the figure for 2005 (22.5%) as the pre-ban measure. We already know from a previous Pell study that the ban had no effect on the smoking rate in the general population. Looking at the ISD figures, it is difficult to see any effect on expectant mothers as well. There is a general downward trend which continued after 2006.

The graph above might actually exaggerate the decline. I was interested to see, upon studying the ISD data, that the smoking ban coincided with (I shall not say caused as I am not a charlatan) a large increase in number of expectant mothers for whom no information on smoking status was available. In other words, more pregnant women are refusing to tell the NHS whether or not they smoke.

The likelihood is that many of these women are smokers but do not wish to be chastisted by the denormalisers of Scotland's health service. This suspicion is supported by the fact that the proportion of pregnant women who are lifelong non-smokers has barely moved for a decade.

Back to the news story...

Experts further found there was a drop of more than 10% in the overall number of babies born "pre-term", which is defined as delivery before 37 weeks' gestation.

There was also a 5% drop in the number of infants born under the expected weight, and a fall of 8% in babies born "very small for gestational size".

This is the meat of the research. As so often, the study has been press released before publication so we cannot see which statistical tricks Pell has employed, but we can use the official NHS records to see how her claims stand up. The data are available here.

The graph below shows preterm births (ie. less than 37 weeks gestation) as a percentage of all live births recorded in Scottish hospitals between 1996 and 2010 (the period that Pell claims to have studied).

The proportion of babies born prematurely in this period remained very constant (between 6.8% and 7.9%). The post-smoking ban years were unremarkable, with percentages of 7.3, 7.4, 7.6 and 7.2 (2007, 2008, 2009 and 2010 respectively). The lowest rate was in 1996. There appears to be no relationship with the general smoking rate, maternal smoking rate or the smoking ban.

I suspect what Pell has done here is taken the highest pre-ban figure (7.9%) and compared it with the lowest post-ban figure (7.2%). The difference between these figures in percentage terms is a little under 9% which, with a bit of statistical massaging, could become "a drop of more than 10% in the overall number of babies born 'pre-term'".

Since preterm births are the major driver behind low birth weights, it should be no surprise that there has been no major change in the number of babies with a low birth weight. Between 97.0% and 97.4% of all full-term pregnancies in Scotland in this period resulted in a baby of normal weight (2500 gm+). I can see no evidence of any 'smoking ban effect' in any of the ISD data. There are moderate random variations and nothing more.

Dr Pell said the research highlighted the positive health benefits which can stem from tobacco control legislation.

To paraphrase Mandy Rice-Davis, she would, wouldn't she?

She said: "These findings add to the growing evidence of the wide-ranging health benefits of smoke-free legislation and support the adoption of such legislation in other countries which have yet to implement smoking bans.

"These reductions occurred both in mothers who smoked and those who had never smoked."

Sorry, what?

"These reductions occurred both in mothers who smoked and those who had never smoked."

Doesn't that tell you something then, Pell? If you are claiming that the smoking ban reduced preterm births because it made people give up smoking, the fact that you found the same result with nonsmokers rather gives the game away, does it not? If, on the other hand, you're suggesting that reducing secondhand smoke miraculously reduces preterm births (I haven't read the study yet, but I wouldn't put it past you to indulge in such superstition), the findings for smokers strongly suggest that this is nonsense as well. Or perhaps you are going to claim that smokers somehow feel the benefit of secondhand smoke reductions as well. Nothing would surprise me at this stage.

"The potential for tobacco control legislation to have a positive effect on health is becoming increasingly clear."

Researchers looked at data for babies born between January 1996 and December 2009, taken from the Scottish Morbidity Record, which collected information on all women discharged from Scottish maternity hospitals.

UPDATE: Michelle Roberts—easily the worst of the BBC's appalling health reporting team—has been suckered by this story. Her entry on Journalisted is an A-Z of pointless epidemiology. I notice the national press have ignored the story, presumably on the basis of 'once bitten'.

Pell's study has appeared on PLoS here. It's short on data but this is her killer graph...

This barely resembles the actual data from Scottish hospitals, but even so it takes a massive leap of faith to attribute the smoking ban to any part of it. The hard line represents the smoking ban, but Pell prefers to use the dotted line because "the Akaike information criterion statistics suggested that using 1 January 2006 as the breakpoint produced a marginally superior model fit than using 26 March 2006." Hey, whatever fits your a priori conclusion the best, Jill.

Even having moved that goalpost, it's plain to see that the fall in preterm births began around ten months before the smoking ban came in. In fact, it came well over a year before, because the timeline Pell is using is the date of conception, not birth. It must have been pretty galling for her to see that the largest drop in her graph preceded the ban and came to an end as soon as the ban came in. Moving the date back to January does not help her much in that respect. Furthermore, even if it had happened after the ban, it would hardly have been proof of anything. There are two little peaks in the graph (as there are in my graph above) followed by two drops. Peaks do tend to be followed by drops, y'know. Maybe Jill Pell should look up 'regression to the mean'.

27 comments:

Beautifully analyzed Chris. I would go a step beyond Dick P's suggestion though. With the three Pell studies you've analyzed as evidence I would think there would be grounds for a serious complaint/investigation of what exactly is going on with her research. You can bet your bupkis that if she'd produced three studies in a row that showed similar results and defects pointing in the exact opposite direction she and her funding would be getting hauled before a University Tribunal or somesuch ... so why shouldn't such concern and examination be equally justified here?

Does her funding come from a truly neutral source that would keep her future grants secure if her findings had all pointed as strongly in the opposite direction? Or is it based from sources that might be considered to have antismoking leanings or connections?

I believe I heard an ASH person try to rake you over the coals on the radio recently because you'd written an article for some group that gets 2% of its budget from BAT or somesuch. How would Jill Pell's track record stand up by comparison? Or does she do all this on a purely volunteer basis?- MJM

Chris, I got the old sinking feeling when I heard the "news" on the radio tonight. What is he going to do about this one, I thought. And hey presto! another cast iron demolition job in double quick time. I suppose once you get the trick of Pell's modus operandi it gets easier? Well not for me. Thanks a million for your unstinting work.

Karragianis, if Big Tobacco attacked her work she'd be held up as a martyr and I think they realize that. If anyone is going to try to set things right it has to come straight from the British citizenry.

Have just complained to the BBC about its lazy, uncritical reporting. But surely something can be done about Pell in the academic community? After hearing the news this morning my first thought was, "Hang on, if it applies to smokers and non-smokers then surely smoking isn't the factor causing the change"? My second thought was to come here to see what was really going on.

Then again, I shouldn't be surprised. It was Pell's heart attack study that first led me to Google the research and ultimately led me to making fighting these charlatans my new part-time job. Until then I stupidly accepted everything I was told by the media. But as an academic myself, even the potted summary on the Today programme was so preposterous I was compelled to look at the actual study itself.... and so, shocked and astounded at what passes for research in the Tobacco Control movement, I joined the fight against junk science and eventually found this site amongst others.

This should interest you (and Michael can attest to my research ability). A few yrs ago I painstakingly went thru CDC stats on US smoking rates in general (a marker for ETS), smoking by pregnant women and incidence of low birth weight. Since I don't know how to do a table in a comment space, here's what I found. In short, low birth weight rose in direct INVERSE proportion to declining smoking rates.

Column A. Year:B. % of US pop that smokedC. % pregnant women who smokedD. % of LBW among all births

It is so heartening to see someone so rigorously demolish the propaganda from the anti-smoking movement. I cannot thank Chris Snowdon enough....

I blew a fuse at the last recent Radio 4 "Today" propaganda news item about "halving of heart attacks due to smoking ban" and for once was so incensed with the blatant media manipulation of the facts that I was moved to write a formal complaint to R4. The gist of it was that James Naughtie didn't ask the obvious questions and actually led the interviewee towards the smoking ban effect comments. Either he did this because he was using his position to promote his own anti-smoking agenda, was coerced into it by senior R4 executives, or he was too dumb to see what questions to ask - either way I resented my money being used to pay his salary and support his position.Needless to say I didn't receive a reply.I agree with other comments above that it is time such suspect science and blatant propaganda is challenged.There are two issues here:-1. How can such propagandists be held to account and forced to justify their wild assertions? - are there no genuine scientists out there prepared to expose them?2. How can Radio 4 be allowed to be so partisan about the reporting of anything to do with smoking without being held to account. I dislike and disapprove of the way Today Programme interviewers' own opinions come across so forcibly when interviewing - surely the BBC at least should be non-partisan and provide matter of fact reporting? Maybe this wouldn't provide as "exciting" news reporting, but does the BBC really want to continue down its "sensationalist rag" approach - it is a public body after all.

I end this as I did my complaint to R4 - "I am exhausted with despair!"

Antismoking concerning pregnancy predates the current wave. Early in the 1900’s it was some church groups (e.g., Methodist Episcopal Church’s Board of Temperance, Prohibition, and Public Morals) that considered nicotine as a “killer of babies.” The “controversy” was picked up by the New York Times in two stories. In one story it was claimed that 40 babies from a New York maternity hospital “suffered from tobacco heart caused by the cigaret smoking of their mothers.” In the other it was claimed that “sixty percent of all babies born of cigaret-smoking mothers die before they reach the age of two, due primarily to nicotine poisoning.” (quoted in Oaks, 2001, p.53; Journal of the American Medical Association, 1929, p.123) The American Tobacco Trust was viewed by the church board as “conscienceless baby-killers” that by promoting cigarettes to women were directing a “lying murderous campaign.”From “Rampant Antismoking Signifies Grave Danger”, p.306

For anyone interested, the book also has a considerable section on the history of issues relating to smoking and pregnancy/early childhood, p.305-335.

The book is available free to download athttp://www.rampant-antismoking.com

This featured on every nes bulletin of the R5L Breakfast Show. This merits a concerted attempt to make the BBC see sense - with copies of emails to Pell. In case she has removed her address, it will be firstname.secondname@glasgow.ac.uk. I suggest sending copies to other interested parties such as, for example, Michael Blastland, More or Less, Inside Health, Andrew Lansley, Straight Statistics.

I couldn't help but wonder if this junk study was held on file ready to be fired off as a press release at just the right time.

I reckon they probably gave it a makeover to denigrate just about everything I said yesterday on radio about pregnant women who smoke occasionally not harming their babies and in the case of lifelong smokers, actually benefitting their pregnancies.

I guess the anti-smoker industry had to then respond by accusing lifelong smokers of not just killing their own babies but everyone else's as well.

Thanks again. Without people like you, I couldn't speak as I did yesterday with such confidence.

Meanwhile, I thought I would check back and see how Pell's most notorious (so far) piece of work is standing up to the cold light of reality.

I mean, of course, the one that 'showed' a 17% drop in emergency admissions for heart attack, in Scotland, in the year following the smoking ban.

Now, if her conclusion were true, then we would rightly expect the heart attack rate to drop by 17% every year, would we not? That would be a clear demonstration of cause and effect. In which case, with some 4 years of data available, one would expect the latest published (2009/10) annual heart attack admission rate to be about 47% (a compound reduction of 53% over 4 years) of what it was prior to the ban (2005/06).

The reality?

Just over 1% fewer!

Really!

There were only a tad over 1%[*] fewer emergency admissions to Scottish hospitals for heart attack, then there were 4 years earlier, in the year before the smoking ban.

Please can we all do what we can to rub Pell's nose in the monstrosity of her failed academic propaganda.

At the very least, remember the simple numbers the next time someone quotes this "17% fall in heart attacks" baloney.

I have no reason to believe that Pell has advanced in the mathematical skills stakes with her latest tripe.

There is little point writing to the BBC about Michelle Roberts. She has a degree in medicine which automatically makes her immune from criticism of any kind by her employer. Pell is also a non-practicing medic. You really could not make “research” this bad up but they do and get away with it. Utterly sickening and deeply dishonest but who cares? Certainly not the BBC, nor the University of Glasgow.

1The question that is typically not asked is how this agenda-driven trash passes for scholarship? Pell occupies a professorship at a university! In typical scientific/coherent enquiry, erratic claims immediately attract peer scrutiny and critique; baseless and over-interpreted conclusions are quickly brought into line. In “lifestyle epidemiology” and pet issues in contemporary Public Health, e.g., anti-tobacco, this self-correcting scrutiny is non-existent. Peer review is useless when all the “peers” are equally daft, where incompetence, lack of integrity, and agenda are endemic. The conduct is anti-scientific and anti-scholarly. Particular university departments with direct access to public policy formulation have become manufacturers of agenda-driven propaganda.

This is not a recent phenomenon. It has been occurring for decades and getting worse. We have Glantz’s, Crapman’s, Daube’s, Banzhaff’s, and a string of others occupying senior university positions that have published agenda-driven trash for decades and that typically attracts no official critique whatsoever. How many critiques in the peer-reviewed medical literature are there of Glantz’s “heart-attack miracles” study? It is this failure of academia that is the lead point in this unfolding insanity.

If Public Health has no coherent self-correction, it would have been expected that other disciplines may have recognized by now that something is terribly astray, e.g., statistics, psychology, philosophy, ethics. Surely there must be some smoker academics, in particular, in other disciplines that would have taken time to examine what is occurring in Public Health, given that the antismoking bandwagon would certainly be affecting their movements. If there are such individuals, they are not making their thoughts known in the mainstream, i.e., published literature. The few critiques that exist are occurring in the blogosphere by people that are not typically in the mainstream. The few others that have voiced concerns are retired from the mainstream, e.g., retired academics, retired physicians.

Consider for a moment that in all the published literature, this long-term, serial assault on scholarship, as is the norm in Public Health, has not been identified/highlighted. Given all the universities around the world, there are no current academics that have come out in force scrutinizing the conduct of Public Health researchers in detail. This is extraordinary. It is catastrophic failure. Academia, on a global scale, repeat - on a global scale, is dangerously lame. Academia has been taken over by the very mentalities that genuine scholarship is supposed to guard against, e.g., fanaticism, superficiality.

2The critical problem in Public Health is its domination by physicalism and the medical model. Health has again been perversely reduced to only a physical phenomenon, e.g., absence of disease. Assaults on psychological, social, moral, and ideo-political health – and their consequences – through agenda-driven propaganda do not register as health issues in physicalism. Medicos, dieticians, and the newly-created “personal trainers” are the “oracles” of the time. Immediately post-WWII, it was this sickly, reductionist definition of health that was identified as the foundational idea of the eugenics madness of Nazi Germany (and America). And, yet, here we are again having learned nothing from very painful lessons of only the recent past.

Public Health and government health bureaucracies have long been dominated by physicalism and the medical model. Newly appointed Health Ministers meet with their health bureaucracy and within days are turned into rabid antismokers able to parrot the standard antismoking rhetoric. There is now an established, entrenched infrastructure from the WHO to countries/governments the world over that forms a closed propaganda loop. The major agent of this network in transforming society is the Health Officer that has typically been trained in some Public Health course. These Health Officers are everywhere; they are in governments and in corporations, small and large. It is these Officers that institute “initiatives”. They have been trained that they should be changing culture (to the edicts of physicalism – whether they know it or not), e.g., anti-tobacco. This social-engineering within physicalism is eugenics, where the major target over the last few decades has been behavior rather than race.

Following the eugenics of America and Nazi Germany, if it was openly proposed immediately post-WWII that the State would sponsor behavior-modification initiatives such as antismoking, there would have been utter outrage, if not more. Yet, whatever was understood then is now gone. Over the last few decades there has been a collective loss of insight, a sort of amnesia. The worldly framework is heading again for disaster – the cost of superficiality – and this time on a far grander scale.

We are now even seeing denial of medical treatment – another eugenics favorite - for the medically-defined “undesirable” and “unworthy”, e.g., smokers, the obese. Again, this conduct could not have been openly advocated/instituted until recently. The conduct is so contrary to the Hippocratic Oath that an outcry would be expected. But there is no outcry. There has been an assault on the Hippocratic Oath for decades similarly to what occurred in the German medical establishment in the lead-up to Nazism. While there is copious [questionable] research on antismoking, little attention is given to the attack on the Hippocratic Oath or, say, iatrogenesis. While certain social groups are declared as “costly” to the system, there is essentially no scrutiny of the squandering of taxpayer funds by the medical establishment that is typically lucrative for those who run the medical production-line: The health budget is a constantly growing “black hole” that is certainly profitable for particular medical groups. While the medical administration demands that all lead a medically/statistically scrutinized/led life, it avoids scrutiny like the plague. These are all terrible, terrible signs.

Just an example on the influence of Health Officers. Over the last few years I’ve kept an eye on antismoking policy at holiday resorts (not that I could afford to attend such). The larger resorts have at least one Health Officer. Smoking bans were first instituted in some 5-star resorts. Smoking was banished to the outdoors generally, then to designated outdoor areas, then to a complete ban indoor/outdoor ban for some resorts. Most 5-star resorts now have severe smoking restrictions. Then the antismoking trickled to the 4-star resorts with the same progression. Now even some 3-star resorts have severe smoking restrictions.

Cruise lines for a time seemed immune to the antismoking madness. But they have caught up quite quickly. And it is the Health Officers that set the policies in motion. They follow the propaganda protocol, e.g., conduct their “polls” that indicate that 70% of travelers don’t want to be exposed to smoke, and the usual inflammatory antismoking rhetoric. So, now, the major cruise lines all have severe smoking restrictions. For some, smoking is not permitted even in cabins and on balconies, and is only permitted in designated outdoor areas. On one major cruise line, smoking is permitted in the cigar lounge, cigarette/pipe smokers not welcome.

The Health Officers are in many, many other corporations. The larger corporations even have on-site gym facilities. The message is constantly reinforced that health is only a physical phenomenon.

The major theme that emerges is that antismoking is elitist as it was earlier last century. It is the wealthy and “educated” that are most prone to medical faddism and supremacism while the poor are little moved by the self-serving propaganda? It is the wealthy and the “educated” that are prone to starting destructive “society/world-fixing” bandwagons?

Consider the eugenics of America and Nazi Germany earlier last century. Eugenics was embraced/funded by the mega-wealthy (e.g., Rockefeller, Ford, Carnegie), the wealthy, and the “educated” in their well-intentioned, albeit terribly misguided, quest to “fix” society; it’s what “proper” people did. While the “educated” snobs sneer down their noses at the poor and their “bad habits” (e.g., smoking) viewing them as burdens to progress that must be “fixed up”, it is the upper classes, when they venture into social engineering to quench their thirst for importance, that pose the greatest danger to society, and only recently helped produce utter catastrophe. And the “proper” people are well on their way again.

It’s not the poor that create social-engineering catastrophes; it’s not the poor that create economic catastrophes due to endemic fraud and greed; it’s not the poor that create political decisions with disastrous ramifications. It’s the white-collar, well-educated folk that are the greatest danger to society. It is they that need constant scrutiny. It’s the poor that usually bear the brunt of the “good intentions” of the educated.

Did some research on her company and found out: It looks like her company was set up for the organisation of the Epidemiology 2011 conference in Edinburgh (http://www.epidemiology2011.com/). Sponsors includes Wellcome Trust (http://www.wellcome.ac.uk/), which looks like a Glaxo version of RWJF. Glaxo is well known for its NRT products.

I wonder how much they sponsored for the conference, which will be visible in the financial details.

In view of the fact that pretty much all of the recent studies have been not just over-exaggerations of convenient sets of mildly supportive statistics, but in fact claims which run completely contrary to the real statistics, as shown above, one wonders whether the antis are really on the defensive now and that their battle plan has morphed into “attack as the best means of defence,” now that their traditional tactics are beginning to run out of steam – largely as a result of their empty promises being highlighted for all to see in the light of successive smoking bans. Rather like Pat's comment above, I now wonder whether they have teams of eager researchers squirreling out any rumoured positive effects of tobacco smoke so that they can immediately issue a “pronouncement” to the opposite effect before those benefits come to light or become well-known to the public.

What they don’t seem to realise, however, is that more and more people simply aren’t interested in statements from “the experts” any more because they no longer trust them (and not just in the realms of smoking, either), but prefer instead to trust the evidence of their own eyes, ears and experiences. How many people, for instance, genuinely believe the recent soundbite (thankfully largely ignored by the MSM) that giving up smoking “will only make you gain an average of three pounds,” when all around them are people they know who have given up smoking and, within a few short weeks developed the all-too-familiar ex-smoker’s hamster-face (the Prime Minister is a good example – a few “before and after” photos are astounding) with a waistline to go with it?

So, although irritating, I see stories like this one as an encouraging sign that anti-smoking is truly now in the descendant, and that it knows it. “Desperate times demand desperate measures,” as they say – and what can possibly be more desperate than deliberately fabricating stories which are so clearly untrue and so easily dismissed? It all smacks of clutching at straws to me ...

About Me

Writer and researcher at the Institute of Economic Affairs. Blogging in a personal capacity.
Author of Selfishness, Greed and Capitalism (2015), The Art of Suppression (2011), The Spirit Level Delusion (2010) and Velvet Glove, Iron Fist (2009).

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"Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience."